Case report https://doi.org/10.12980/apjtd.7.2017D6-341 ©2017 by the Asian Pacific Journal of Tropical Disease. All rights reserved.
Sanjay Kumar1, Pratap Singh1*, Vijay Kumar2, Mukesh Verma1, Satender Pal Singh1
1
Department of Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
2
Department of pathology, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
A RT I C L E I N F O A B S T R AC T
Article history: We present a case of a 40-year old male who presented with complaints of generalized weakness,
Received 28 Sep 2016 lethargy, breathlessness on exertion, easy fatigability for a 2-month duration. He also had
Received in revised form 24 Oct, 2nd the history of mild bleeding from gums and nose since 2 days ago and had pallor on general
revised form 25 Oct 2016 physical examination. The peripheral smear revealed pancytopenia with several microfilariae
Accepted 15 Nov 2016 in the buffy coat. Bone marrow aspiration showed hypocellular marrow with microfilariasis
Available online 23 Dec 2016 and increase in mature plasma cells. The patient was starting on diethylcarbamazine. However,
his bone marrow aspirate done 2 weeks later showed hypocellular marrow with no parasites
and biopsy showed picture that was suggestive of aplastic anemia. He was later referred to
Keywords: higher center for further investigation and management. Pancytopenia as a presenting feature
Filariasis of filariasis is rare, but a few case reports have been published. Yet a causal relationship of
Aplastic anemia filariasis and pancytopenia, hypoplasia or aplasia of bone marrow has not been determined.
Pancytopenia It has also not been proved that a treatment of filariasis has led to a reversal of bone marrow
Microfilaria hypoplasia or aplasia.
24%, mean corpuscular volume 70 fL, corrected reticulocyte count filariasis is the cause of bone marrow suppression or an incidental
0.5%, and serum lactate dehydrogenase 352 IU/L. His HIV, anti- finding is still not fully understood. Thus, any patient with
hepatitis C virus and hepatitis B surface antigen were non-reactive. pancytopenia with microfilariasis should be evaluated with bone
Ultrasound abdomen revealed stones in gall bladder. Bone marrow marrow biopsy to rule out aplastic anemia.
aspiration showed hypocellular marrow with microfilariasis with An association of acute lymphoblastic leukemia and filariasis has
pancytopenia and increase in mature plasma cells along with several been reported in literature but the author concluded that it is possible
microfilariae in the buffy coat of peripheral smear (Figure 1). Bone that the immunocompromised status of the patient due to leukaemia
marrow aspiration done 2 weeks later showed hypocellular marrow had made the patient more susceptible for filarial infection[7]. In
with no parasites and biopsy showed picture that was suggestive of another case report, microfilaria was detected in bone marrow of a
aplastic anemia. patient with multiple myeloma. As previously stated, it needs further
investigation about whether this was a chance finding or causative
association. However, the authors concluded that it was a chance
finding[8].
Any patient with pancytopenia in endemic region should also be
evaluated with bone marrow aspiration for microfilariasis. Bone
marrow filariasis can present as hypoplastic or aplastic anemia.
Microfilariasis can also be seen in atypical sites like subcutaneous
swellings, breast, thyroid, lymph nodes, effusions, cervical scrape,
eyeball, sputum and bronchial washing. Further investigations
are needed to understand the possible etiological role of filariasis
in various hematological manifestations such as pancytopenia,
hypoplastic or aplastic anemia.
Figure 1. Moderately cellular bone marrow aspiration smear showing Conflict of interest statement
microfilaria (arrow) with interspersed scattered lymphocytes, maturing
myeloid forms, few normoblastic erythroid cells and plasma cells (Giemsa
We declare that we have no conflict of interest.
stain, 200× amplification).